Basic Information
| Provider Information | |||||||||
| NPI: | 1992972731 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PARKVIEW ANCILLARY SERVICES | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PARKVIEW BEHAVIORAL SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 N GRAND AVE | ||||||||
| Address2: | STE 150 | ||||||||
| City: | PUEBLO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 810032700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195957705 | ||||||||
| FaxNumber: | 7195957719 | ||||||||
| Practice Location | |||||||||
| Address1: | 56 CLUB MANOR DR | ||||||||
| Address2: | STE 100 | ||||||||
| City: | PUEBLO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 810081679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195844767 | ||||||||
| FaxNumber: | 7195844808 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2008 | ||||||||
| LastUpdateDate: | 05/12/2008 | ||||||||
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| AuthorizedOfficialLastName: | PATTERSON | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7195844000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TH0100X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Health Service |
No ID Information.